Dirty Little Secrets

1. "We're not going to tell you your doctor is incompetent, but if I say, 'You have the right to a second opinion,' that can be code for 'I don't like your doctor' or 'I don't trust your doctor.'" — Linda Bell, RN, clinical practice specialist at the American Association of Critical-Care Nurses in Aliso Viejo, California2. "When a patient is terminally ill, sometimes the doctor won't order enough pain medication. If the patient is suffering, we'll sometimes give more than what the doctor said and ask him later to change the order. People will probably howl now that I've said it out loud, but you have to take care of your patient." — A longtime nurse in Texas

3. "Feel free to tell us about your personal life, but know that we're here for 12 hours with nothing to talk about. So the stuff you tell us will probably get repeated." — A nurse in St. Petersburg, Florida4. "A lot of my patients are incontinent, and I'm supposed to just use a wet washcloth to clean them. But if it's a patient who's been really nice and appreciative, I'll go all the way to intensive care to get some of the heated wet wipes, which are a lot more gentle. Somebody who's constantly yelling at me? I just use the washcloth." — A nurse in St. Petersburg, Florida

What We're Really Thinking

5. "I've had people blow out arteries in front of me, where I know the patient could bleed to death within minutes. I've had people with brains literally coming out of their head. No matter how worried I am, I'll say calmly, 'Hmmm, let me give the doctor a call and have him come look at that.'" — A longtime nurse in Texas6. "I'd never tell a patient that he's a moron for waiting a week for his stroke symptoms to improve before coming to the hospital. Although I'd like to. Especially if his wife then complains that we're not doing anything for the guy." — A longtime nurse who blogs at head-nurse.blogspot.com

7. "If you're happily texting and laughing with your friends until the second you spot me walking into your room, I'm not going to believe that your pain is a ten out of ten." — A nurse in New York City

8. "When you tell me how much you drink or smoke or how often you do drugs, I automatically double or triple it." — A longtime nurse in Texas

9. "Your life is in our hands — literally. We question physicians' orders more often than you might think. Some of the mistakes I've headed off: a physician who forgot to order a medication that the patient was taking at home, a doctor who ordered the incorrect diet for a diabetic, and one who tried to perform a treatment on the wrong patient." — A nurse from Pennsylvania

10. "These days, you can't get admitted unless you're really sick, and you'll probably get sent home before you're really ready. So we don't get any easy ones anymore." — Kathy Stephens Williams, RN, staff development educator for critical care at St. Anthony's Medical Center in St. Louis, Missouri

11. "People have no idea of the amount of red tape and charting we have to deal with every day. We spend hours at the computer just clicking boxes. They tell us, 'If it wasn't charted, it didn't happen.' So I always chart with a jury in the back of my mind." — An intensive-care nurse in California12. "Despite nurses' best efforts, hospitals are still filthy and full of drug-resistant germs. I don't even bring my shoes into the house when I get home." — Gina, a nurse who blogs at codeblog.com

13. "The No. 1 thing you should never say to me: 'You're too smart to be a nurse.' I went to nursing school because I wanted to be a nurse, not because I wanted to be a doctor and didn't make it." — A longtime nurse in Texas14. "Grey's Anatomy? We watch it and laugh. Ninety percent of the things doctors do on the show are things that nurses do in real life. Plus, there's no time to sit in patients' rooms like that." — Kathy Stephens Williams, RN

15. "The sicker you are, the less you complain. I'll have a dying patient with horrible chest pain who says nothing, because he doesn't want to bother me. But the guy with the infected toe — he can't leave me alone." — An intensive-care nurse in California
16. "No matter how many times you use your call light, even if it's every ten minutes, I will come into your room with a smile. However, if you don't really need help, I will go back to the nurses' station and complain, and this may affect how the nurses on the next shift take care of you." — A cardiac nurse in San Jose, California17. "When your provider asks for a list of the medications you're taking, make sure you include over-the-counter drugs and herbals. People think that if an herb is 'all natural' and 'organic,' it's not a medication. But that's not true. Herbals can interact with other medications and can cause serious complications." — Kristin Baird, RN, a health-care consultant in Fort Atkinson, Wisconsin

18. "This is a hospital, not a hotel. I'm sorry the food isn't the best, and no, your boyfriend can't sleep in the bed with you." — A nurse in New York City19. "I know you asked for mashed potatoes, but that sound you hear is my other patient’s ventilator going off." — A nurse in New York City

What We Lie About

20. "If you ask me if your biopsy results have come back yet, I may say no even if they have, because the doctor is really the best person to tell you. He can answer all your questions." — Gina, a nurse who blogs at codeblog.com21. "When you ask me, 'Have you ever done this before?' I'll always say yes. Even if I haven’t." — A nurse in New York City

What Hurts Our Feelings

22. "In my first nursing job, some of the more senior nurses on the floor refused to help me when I really needed it, and they corrected my inevitable mistakes loudly and in public. It's a very stressful job, so we take it out on each other." — Theresa Brown, RN, an oncology nurse and the author of Critical Care: A New Nurse Faces Death, Life, and Everything in Between23. "It can be intimidating when you see a physician who is known for being a real ogre make a mistake. Yes, you want to protect your patient, but there's always a worry: Am I asking for a verbal slap in the face?" — Linda Bell, RN24. "Every nurse has had a doctor blame her in front of a patient for something that is not her fault. They're basically telling the patient, 'You can't trust your nurse.'" —Theresa Brown, RN

What We Love

25. "If you have a really great nurse, a note to her nurse manager that says 'So-and-so was exceptional for this reason' will go a long way. Those things come out in her evaluation — it's huge." — Linda Bell, RN26. "If you've been a patient in a unit for a long time, come back and visit. We'll remember you, and we'd love to see you healthy." — An intensive-care nurse in California

27. "I once took care of a child who had been in a coma for more than a week. The odds that he would wake up were declining, but I had read that the sense of smell was the last thing to go. So I told his mom, 'Put your perfume on a diaper and hold it up by his nose to see if it will trigger something.' The child woke up three hours later. It was probably a coincidence, but it was one of my best moments as a nurse." — Barbara Dehn, RN, a nurse-practitioner in Silicon Valley who blogs at nursebarb.com

How to Get Great Care

28. "Now that medical records are computerized, a lot of nurses or doctors read the screen while you're trying to talk to them. If you feel like you're not being heard, say, 'I need your undivided attention for a moment.'" — Kristin Baird, RN29. "Never talk to a nurse while she's getting your medications ready. The more conversation there is, the more potential there is for error." — Linda Bell, RN30. "Some jobs are physically demanding. Some are mentally demanding. Some are emotionally demanding. Nursing is all three. If you have a problem with a nurse or with your care, ask to speak to the charge nurse (the one who oversees the shift). If it isn't resolved at that level, ask for the hospital supervisor." — Nancy Brown, RN, a longtime nurse in Seattle

31. "If the person drawing your blood misses your vein the first time, ask for someone else. I've seen one person stick someone three times. They need to practice, but it shouldn't be on you!" — Karon White Gibson, RN, producer-host of Outspoken with Karon, a Chicago cable TV show32. "Never let your pain get out of control. Using a scale of zero to ten, with ten being the worst pain you can imagine, start asking for medication when your pain gets to a four. If you let it get really bad, it's more difficult to get it under control." — Nancy Beck, RN, a nurse at a Missouri hospital33. "Ask the nurse to wet your bandage or dressing before removal — it won’t hurt as much." — Karon White Gibson, RN

34. "If you're going to get blood drawn, drink two or three glasses of water beforehand. If you're dehydrated, it's a lot harder for us to find a vein, which means more poking with the needle."
35. "Don't hold your breath when you know we're about to do something painful, like remove a tube or take the staples out of an incision. Doing that will just make it worse. Take a few deep breaths instead." — Mary Pat Aust, RN, clinical practice specialist at American Association of Critical-Care Nurses in Aliso Viejo, California

The Truth About Doctors

36. "If you have a choice, don't go into the hospital in July. That's when the new crop of residents starts, and they're pretty clueless." — A nurse supervisor at a New Jersey hospital37. "Doctors don't always tell you everything. They'll be in the hallway saying, 'She has a very poor prognosis. There's nothing we can do.' Then they don't say that in the room. Sometimes I try to persuade them to be more up-front, but I don't always succeed." — Theresa Brown, RN

38. "There are a few doctors at every hospital who just don't think that they need to wash their hands between seeing patients. Others get distracted and forget. So always ask anyone who comes into your room, 'Have you washed your hands?'" — Kathy Stephens Williams, RN39. "Many doctors seem to have a lack of concern about pain. I've seen physicians perform very painful treatments without giving sedatives or pain medicine in advance, so the patient wakes up in agony. When they do order pain medicine, they're so concerned about overdosing, they often end up underdosing." — A nurse supervisor at a New Jersey hospital

40. "When you're with someone who is dying, try to get in bed and snuggle with them. Often they feel very alone and just want to be touched. Many times my patients will tell me, 'I'm living with cancer but dying from lack of affection.'" — Barbara Dehn, RN, NP41. "It's the little things that make a difference for people who are sick. One of the best things you can do is wrap them in a warm blanket or towel. Throw the towel in the dryer before they are bathed. If they're in a hospital, find out where the blanket warmer is." — Barbara Dehn, RN, NP
42. "I'll never tell you to change your code status to Do Not Resuscitate, even though I might cringe at the thought of having to break your ribs during CPR. With certain patients, however, I may talk to family members to clarify their goals for the patient's care. This sometimes leads to an elderly person being placed on comfort care rather than being continually tortured by us with procedures that aren't going to help." — A cardiac nurse in San Jose, California

More Things We Want You to Know

43. "Husbands, listen to your wives if they tell you to go to the hospital. Today a man kept fainting but wouldn't go to the hospital until his wife forced him. He needed not one, not two, but three units of blood — he was bleeding internally. He could have had a cardiac arrest. Another man complained to his wife that he didn't feel 'right.' His wife finally called me to come over to their house. His pulse was 40. He got a pacemaker that evening." — Barbara Dehn, RN, NP44. "The doctors don't save you; we do. We're the ones keeping an eye on your electrolytes, your fluids, whether you're running a fever. We're often the ones who decide whether you need a feeding tube or a central line for your IV. And we're the ones who yell and screech when something goes wrong." — A longtime nurse in Texas

45. "If you do not understand what the doctor is telling you, say so! I once heard a doctor telling his patient that the tumor was benign, and the patient thought that benign meant that he had cancer. That patient was my dad. It was one of the things that inspired me to become a nurse." — Theresa Tomeo, RN, a nurse at the Beth Abraham Center for Nursing and Rehabilitation in Queens, New York46. "At the end of an appointment, ask yourself: Do I know what's happening next? If you had blood drawn, find out who's calling who with the results, and when. People assume that if they haven't heard from anyone, nothing is wrong. But I've heard horror stories. One positive biopsy sat under a pile of papers for three weeks." — Kristin Baird, RN

47. "As a nurse, sometimes you do nothing but run numbers and replenish fluids. Sometimes you're also the person who reassures the teenager that 'everybody' gets her period on the day of admission, the person who, though 30 years younger than the patient, tells that patient without blushing or stammering that yes, sex is possible even after neck surgery. You're the person who knows not only the various ways to save somebody else's life but also how to comfort those left behind." — A longtime nurse who blogs at head-nurse.blogspot.com

How to Be a Great Patient

48. "I had one patient show up repeatedly to see me after he was discharged. Another little old man tried to pull me into bed with him. (He was stronger than he looked.) The general rule is don't ask us on a date. We're busy. It's unethical. And, really, I already know you better than I want to." — A longtime nurse in Texas49. "Positive attitude is everything. I have seen many people think themselves well." — Nancy Beck, RN50. "A simple 'Thank you' can really make my day." — A nurse in New York City